CN1113745A

CN1113745A - Spine osteosynthesis instrumentation for an anterior approach

Info

Publication number: CN1113745A
Application number: CN 94106971
Authority: CN
Inventors: C·霍夫
Original assignee: Sofamor Danek Group Inc
Current assignee: Medtronic Sofamor Danek Inc
Priority date: 1994-05-09
Filing date: 1994-05-09
Publication date: 1995-12-27

Abstract

The invented equipment contains at least two connecting blocks which are adaptable for laterally connecting two rigid bars which can be axially slided on the connecting blocks. The connecting block is equipped with a properly-orientated bone anchoring screw and a slide block which can be slided along the longitudinal groove in which the bar can be received. After both slide blocks are fully closed, the bar can be held by them. Each connecting block laterally has the arc configuration corresponding to the anterolateral form of vertebral body from front end to back end, and its internal surface is concave, and its external surface is convex. The equipment consisting of two connecting blocks, anchoring screws and reinforcing bars forms an axially continuity and very stable rectangular structure used for restoring spinal column, and can prevent the movement in the cours of correction, and can be favourable for consolidation of bone graft.

Description

Spine osteosynthesis instrumentation for an anterior approach

The present invention relates to a kind of preceding proximity (an anterior approach) spinal column osteosynthesis apparatus.

In the spinal instrumentation field, back proximity (aposterior approach) apparatus has been carried out exploring widely, this back proximity apparatus is to many diseases a kind of valuable medical apparatus and instruments of still can yet be regarded as.

But this technology has some defectives like this, does not promptly allow directly to enter vertebral body, and this usually is limited to its use, and has promoted the exploration of another kind near mode (proximity for example).

Though preceding proximity apparatus is much meticulousr and complicated than back proximity apparatus, this apparatus has been opened a wide research field.Though thisly require hospital will have many technical equipments and environmental condition, and need carry out special training, the exploration in this field is remained very necessary to very high-grade special orthopedist near mode.

According to the position height (level) of the vertebra that will touch, carried out the practice that several preceding proximity enter technology at present.The proximity operation was before these were several:

The transpleural breast corridor otomy of chest;

The breast of breast loin-every the waist otomy;

The waist otomy of waist.

For each of above-mentioned operation, because the right side of spinal column is near the venous lumen vein of and more difficult processing more fragile than aorta, although therefore close aorta had better tap into from the left side of spinal column.

Yet, still influential for the installation of apparatus along the large vein that vertebral body extends.

Utilize the preceding technology of back of the body lumbar spine also to be used near method:

Or in order to correct skoliosis and to keep its rectification state,

Or in order to treat hunchback or dihedral hunchback than larger radius of curvature.

Some surgeon have worry to this technology.But, have recognized that now it truly has benefit for some treatment of conditions.It is for some disease or even requisite.

No matter which type of idea the party of surgery institute has in spinal instrumentation, and all surgeon admit that this technology has following advantage:

The corrigent improvement of torsiversion of vertical post and the improvement of the scoliotic rectification effect in waist-back have been obtained;

Obtained the raising of apparatus stability, the improvement of bow-backed rectification effect, the improvement of nerve decompression.

Anterior position and position, middle part direct observation vertebra part to be treated at spinal column.

Use length short apparatus and fusion;

Higher fusion rate, the degree near 95%;

Owing to, and, can reduce the risk of marrow damage by the necessary dispersion of rear portion action do directly near spinal cord.

These advantages are not comprehensive certainly, and are more described below also having: improved effect of easing stress, and therefore non-destructive can keep the stability tissue at rear portion, for example muscle and ligament, or the like.

Because due to the interest of a kind of proximity apparatus that advances of development, many kinds of technical recommendations were suggested already, can be summarized as following several:

Use the device of plate or analog, the two ends of plate are fixed on the vertebra, and are positioned at the both sides at vertebra position to be treated;

Use bar, be generally the device of two bars, undertaken fixedly connectedly between two bars by a transverse beam, two bars are fixed on the crossbeam thereby form a rectangular frame.

The every kind of structure that is proposed all has its advantage, but its shortcoming is also arranged, and the result is that said device does not have or seldom is used.

Two known examples have:

French Patent (FRP) No. 2651992 (8912187, the invention people is J.M.LANRAIN) proposes to use a kind of inflexible plate.This device is suitable for the special requirement of the fracture and the tumor at degeneration position, but is suitable for the vertebra distortion hardly.

French Patent (FRP) No. 2658413 (9001970, the invention people is J.DUBOUSSET) proposes to use two two metallic rod along spinal fixation, is connected by a horizontal beam between two metallic rod, makes device have the structure of a rectangular frame.

This technical scheme is applicable to the situation of deformation of spinal column preferably, but still can not satisfy all technology and operating requirement.

Particularly, the part count of constituent apparatus is more, and this means needs long operating time, although therefore this device is comparatively effective, required expense is higher, thereby has hindered its popularization and the marketization.In brief, preceding proximity apparatus is very fine, thereby brings bigger risk to the surgeon, and technical innovation and creation should make great efforts this risk is reduced to floor level.

Therefore, an object of the present invention is to provide a kind of device, it can overcome these shortcomings, thereby can treat fracture in the mode that is entirely satisfactory, tumor and spinal column deformation.

The invention provides a kind of device, it comprise two that be parallel to each other or be included in two inflexible bars in two parallel planes, at least two contiguous blocks that are used for laterally connecting said bar, said connection is by this way, be that bar can carry out axial slip and can rotating around self in contiguous block, device has and clamps bar and make its mechanism that can not rotate and move in the said contiguous block, also is included as fixedly connected used bone anchoring members (bone anchorage elements).

Two contiguous blocks have constituted rectangular frame with two bars that link to each other, and it provides required whole stability for the axial seriality of recovering spinal column, and avoided correcting and moved, and the consolidation that helps bone to transplant.

According to one embodiment of present invention, each contiguous block laterally (promptly from basivertebral front portion to the rear portion) have one with basivertebral before outside anatomical shape is corresponding is roughly arcual shape, it is recessed that expectation will be placed into the inner surface that vertebral body gets on, and outer surface protrudes.

According to other feature:

Face the radius of curvature of curvature half radius of basivertebral forward recessed surfaces less than the outer surface of projection.

Formed two parallel grooves longitudinally on each contiguous block, the sliding shoe that is used to admit corresponding bar He is used for anchorage bar, said sliding shoe can carry out longitudinal sliding motion in corresponding grooves, and at the terminal point of its slip bar are tightened up.

Each sliding shoe is provided with the side flange of inclination, is used for matching with complementary side channel on the groove, matches in the fastening slope that is provided with on said flange and the said groove, and perhaps conversely, flange tilts, and matches with the fastening slope that is provided with on the groove.

In a possible embodiment of the present invention, contiguous block is crooked, thereby has the S-shaped basically cross sectional shape of a kind of tool, two parts before and after its two halves constitute respectively, the thickness of first half can be inserted among the pit that is provided with for this purpose on the vertebral body less than latter half of thickness.

Further feature and advantage will be along with knowing among the explanation of doing below in conjunction with accompanying drawing that as can be known, following explanation has provided several embodiment of the present invention by several nonrestrictive examples.

In the accompanying drawings,

Fig. 1 is the fragmentary, perspective view according to first kind of embodiment of a kind of preceding proximity spinal column osteosynthesis apparatus of the present invention.

Fig. 2 is the perspective view according to the sliding shoe of one that draws than the ratio of the large percentage of Fig. 1 groove that is used for the contiguous block shown in closed Fig. 1.

Fig. 3 is the perspective view of one of contiguous block of this apparatus slightly littler than Fig. 2 ratio.

Fig. 4 is the partial top view of Fig. 1 to apparatus shown in Figure 3.

Fig. 5 is the cutaway view that the 5-5 line in Fig. 4 is cut open.

Fig. 6 is the cutaway view of the 6-6 line in Fig. 4.

Fig. 7 is the front view of Fig. 4 to apparatus shown in Figure 6.

Fig. 8 is the front view of the contiguous block of second kind of embodiment of the present invention.

Fig. 9 is the vertical view of contiguous block shown in Figure 8.

Figure 10 be along partly facing of cutting open of the 10-10 line of Fig. 9 and, half sectional view.

Figure 11 is according to the partial top view of Fig. 8 to the apparatus of embodiment shown in Figure 10.

Figure 12 is the front view of screw described in Figure 11 and contiguous block, and the part of its king-rod is represented with cutaway view.

Figure 13 is vertebra and Fig. 8 vertical view when being fixed on the said vertebra to contiguous block shown in Figure 12, also has a dispersion-compressing instrument simultaneously, and the one end is meshed with a horizontal opening that is provided with on contiguous block for this purpose.

Figure 14 is the front view of Fig. 1 to Fig. 7 instrument shown when placing three joint vertebraes to constitute on one section spinal segment position.

Fig. 1 to shown in Figure 7 a kind of before proximity spinal column osteosynthesis apparatus comprise two contiguous blocks 1 at least, they be used for two parallel to each other and can be on contiguous block in axial sliding

rigid rod

2 and 3 transversely link.Shown apparatus is in its vertical position and draws according to observing from left of spine.Have on the contiguous block 1 and clamp

rigid rod

2,3 and it can't be rotated and the mechanism of translation, each contiguous block also comprises two

sliding shoes

4,5, they respectively in the groove on

contiguous block

1,26,7 with direction that

rigid posts

2,3 parallels on translation.

Each

contiguous block

1,2 also has two bone hold-down

screws

8,10, and by being inserted into the

corresponding hole

9,11 that is arranged on

groove

6,7 bottoms,

screw

8,10 can be placed on desired

location.Hole

9,11 and

screw

8,10 have suitable angle of inclination, thereby two screws can converge mutually with suitable angle, preferably converge with 25 ° angle.

Screw 8,10 preferably has cone point, its tapering is corresponding with the tapering in

hole

9,11, thereby when they were inserted into the bottom of admittance groove of the bottom of

groove

6,7 or

semi-cylindrical bar

2,3, they can not given prominence to, can be owing to the existence of bar yet axially in abutting connection with the time hindered.

All have some depression positions 55 on each groove surfaces (Fig. 3), its effect is to help to support the card punch (not shown), provides a hole before forming

hole

9,11.

From basivertebral front portion towards laterally (these vertebras must be fixing with

screw

8,10 on this direction) at rear portion, each

contiguous block

1,2 have the roughly shape of camber, and this shape matches especially as shown in Figs. 5 to 7 and with these basivertebral front side anatomical shapes.Therefore, from its front surface S ₁, to rear surface S ₂Be essentially a convex, and be fit to fit in basivertebral inner surface S ₃Then be recessed.

Each

contiguous block

1,2 has and is essentially orthogonal overall shape, and its forward thickness is less than the thickness at rear portion, and its

edge

12, and 12a is circular.Correspondingly, front surface S ₁Radius of curvature be significantly less than rear surface S ₂Radius of curvature.

Upper surface (the S of each contiguous block ₂, S ₁) be level and smooth, because the surface of

slide block

4,5 flushes with the circumferential surface of contiguous block, therefore avoided any possible projection.Two grooves are being parallel to each other in one direction and are extending, and are respectively applied for a part of admitting bar 2,3: the diameter of back bar 2 is obviously greater than bar 3, and its reason will be explained hereinafter.The integral body of this apparatus is placed in the left side of spinal column under major part shape, and makes bar 2 be positioned at rearward position.

Be provided with a

semi-cylindrical raceway groove

13,14 in the bottom of each

groove

6,7, its diameter diameter with

bar

2,3 respectively is suitable.In addition, two side channel 15a parallel to each other of processing on the sidewall of each

groove

6,7,16a and 15b, 16b.These side channels are used to hold the

corresponding side flange

17,18,19,20 on slide block 4 and 5.Because the unsymmetry between the front and rear portions of each contiguous block 1,

flange

17,18 and flange the 19, the 20th are provided with according to different substantially modes, as seeing among Fig. 5 to 7.Therefore, (being provided with 16b) equally also is that mode by different basically designs to groove corresponding with it for 15a, 16a and 15b.

Flange

17,18 and 19,20 in the bottom of groove according to they corresponding

side channel

15a, 15b, 16a, the mode that 16b the is identical suitable angle A (as shown in Figure 2) that tilts, for this purpose,

side channel

15a, 15b, 16a, 16b such as flange 17 ... the 20 the same inclined slopes that are all A with an angle.Therefore, each sliding

shoe

4,5

inserts corresponding grooves

6,7 gradually along arrow (Fig. 1 and Fig. 4) direction and can cause

flange

17,18 and 19,20 at its

groove

15a, 16a ... in clamped gradually, at last sliding shoe is clamped among the

groove.Sliding shoe

4 and 5 upper flanges (17 ... 20) inclination angle is opposite, is inserted

groove

6,7 thereby the latter presses the opposite direction shown in the arrow (Fig. 1 and Fig. 4), to obtain a kind of effect that will explain

hereinafter.Flange

17,18 and 19,20 and the inclination angle on slope can be between 2～6 °.

Flange (19 ... 20) upstream end preferably is processed to have chamfering or slick and sly edge, and for example 17a(as shown in Figure 2).Correspondingly,

groove

6,7 also has chamfering, do not draw in Fig. 1 to Fig. 7, but Fig. 8 to Figure 12 (50,51) has demonstrated this point.17a matches with chamfering, and these chamferings help sliding

shoe

4,5 to insert its

groove

6,7.

Should be noted in the discussion above that

semi-cylindrical groove

13,14 certainly with corresponding sliding shoes 4,5(Fig. 5 to Fig. 7) on

groove

21,22 constitute relatively one cylindrical.

Can have the complementary retention mechanism of establishing for sliding

shoe

4,5 on each contiguous block 1.In the embodiment that is introduced, for each sliding

shoe

4,5, these retention mechanisms comprise a

screw

23,24, and they are inserted among the opening 25,26 of the central part that is positioned at the contiguous block between the groove 6,7.The opening of offering for screw 23 25 is connected by the adjacent slot 16b of a horizontal passage 27 with the side flange 19 of sliding shoe 5.Similarly, the opening 27 of the passage between the groove 16a of the flange 18 of the opening 26 of screw shown in Fig. 5 24 and sliding shoe 4.Each

screw

23,24, from the one end to its other end, have one and attack threaded bone grappling fixed bar 28, one towards 29, one of gradually thin tapering parts of lead screw 28 directions towards the gradually thin fracture circular cone of tapering part (fracure cone) 31, and head of screw 32.

The termination of threaded portion 28 is round, and basically with the inner surface S of contiguous block 1 ₃Mutually concordant.The size of threaded portion 28 and tapering part 29 is like this designs, makes the latter see Fig. 5 and Fig. 6 by passage lanes 27(as tapering part 29) opening be close to adjacent flange on the corresponding sliding

shoe

4,5.

In the front portion of each contiguous block, at surperficial S ₁Between upper groove 7 and the rounded edges 12, be provided with an aperture 34.This aperture 34 has been used to admit a utensil 36(who disperses compressing as shown in figure 12) rounded nose 35, this utensil itself belongs to prior art, need not description.

The implantation of contiguous block 1 or " clamp-type contiguous block " need be used special assistive device:

Be used to install the assistive device of sliding shoe 4,5:,, be provided with an assurance and assistive device effectively and bonded securely notch promptly at their free-ended edge at each side of sliding shoe;

Be used to install the auxiliary device of contiguous block 1: be arranged on contiguous block 1(and see Fig. 1) the opening 27 of central part help to connect;

Disperse assistive device: the forward hole 34 that is arranged in contiguous block 1 can allow to disperse any be connected of assistive device and the piece 1 that is clamped and connected.

The diameter of the bar 2 at rear portion can be 4 to 7 millimeters, and the diameter of forward bar 3 is less, is 3 to 6 millimeters.The difference of this diameter can be by following facts explain: main power is applied on the rear link 2, particularly because the derotation applied force.On the other hand, forward bar 3 is subjected to less mechanical force, therefore can have less diameter.In addition, forward bar is nearest apart from the large vein blood vessel, so the raising that reduces to bring this apparatus operation safety degree of its diameter.But the difference of diameter is not requisite, and two bars 2 also can have identical diameter with 3.

Figure 14 expresses a kind of embodiment of apparatus of the present invention, and it is by along by three joint vertebra L ₃, L ₂, L ₁The device of the weak point that the vertebra section of forming is extended constitutes.The erection sequence of each parts of this apparatus is as follows:

Contiguous block 1 is positioned over and is fixed on vertebral body L by

pyramidal screw

8,10 ₃The preceding outside.Another contiguous block 1 also is placed on the appropriate position, is fixed to spinal bone L with the same manner then ₁On, vertebra L ₂Vertebra for the need treatment.

The rear link 2 of a diameter 6mm is placed among the rear groove 6 of lower connecting block.By a suitable assistive device, will be installed in corresponding to the sliding part 4 at the rear portion of groove 6 on their corresponding inclined slope 6a and the 7a, and its upside with bar 2 is contacted.Therefore this bar is limited among the groove 6 of contiguous block, but still can carry out translation and rotation under the effect of external force.Here it is why two slide blocks are positioned at they the clamping slope or the centre position on to make it possible to act on described bar with being perfectly safe and not allow through breaking away from the reason of its place groove.Therefore, slide block is not pushed to the terminal point on its slope.

Such centre position of sliding shoe can make the surgeon when needed by making back bar 2 around himself rotating and spinal column being applied a derotation effect.The derotation effect is corresponding therewith, and bar 2 is in one with respect to the new position that connects groove 6, and this position is automatic acquisition of character that is changed according to acting in the spinal column owing to this derotation.

Then preceding bar 3(is for example had the diameter of 4mm and have with embodiment illustrated in fig. 14 in the identical length of back bar) insert in the forward recess 7 of upper and lower contiguous block.As the sliding part of bar 2 and groove 6, advancing slip motion block 5 is installed on its corresponding slope, and it is installed and guarantees that bar 3 is in confined position but the while can fully freely be moved particularly translational motion again.Therefore, they are also incomplete to the chucking power of bar, because they are not also by the final position to its slope.

Therefore, according to the condition of illness of required treatment, by means of auxiliary device 36 or similar auxiliary device, the surgeon just can carry out intervertebral compressing or disperse operation, and the screw 35 of assistive device inserts and is arranged in the forward hole of two contiguous blocks.

In case obtain required dispersion or compressing, all sliding

shoes

4,5 of contiguous block all are pushed to the terminal point on its corresponding slope, thereby bar 2,3 is applied the pressure of holding with a firm grip that increases gradually, thereby with

bar

2,3 are clamped among its

corresponding grooves

6,7 securely, prevent to rotate and move.

In

case sliding shoe

4,5 is by fastening fully, the installation of apparatus has promptly been finished.Because the structure at contiguous block of the present invention need not add the optional feature such as horizontal connecting rod, promptly can obtain the effect of a kind of rectangle or frame shape apparatus, and is similar with the flat effect that structure obtained.

At last, extra safety can be arranged,

screw

23,24 patchholes 25,267 are tightened, then they be fractureed at the fracture nose cone position that is provided with that fractures for it in order to make the clamping in its groove of bar and sliding part.

When considering the structure of apparatus of the present invention, the very important point is exactly the reliability of wanting attention device, a particularly contiguous block reliability of fixation on vertebra.Grappling hold-down screw 8,10th specially is arranged on the bottom of groove, and preferably has a corresponding conical nose of tapering (as illustrated in Figures 5 and 6) with

hole

9,11, and its head can be not outstanding in the half-

cylindrical groove

13,14 of admitting

bar

2,3 as a result.

After apparatus is really implemented to finish, promptly closed fully sliding

part

4,5, be anchored hold-

down screw

8,10 fastening after, device can not come off from the spinal column that they were inserted under the effect of the various motions of patient body.Their axial displacement is impossible, and the result is if the fracture of its length part, and two screw positions still can be firmly fixed, and still keep contiguous block motionless.

The sliding shoe that shall also be noted that each bar is in same axial insertion, but in these two bars each, the direction of insertion of its sliding shoe is opposite with another, as Fig. 1, is labeled in 4 and 11 shown in the arrow of upper surface of sliding shoe 4,5.In this manner, when groove 6, when 7 slope is provided with to such an extent that allow the sliding shoe of each fixed block 1 to insert so on the contrary, after slide block was held the location, patient's various motions were applied to all power that being tending towards on the bar unclamp this device and are all taken away by another bar in the opposite direction and be used to apply clamping force.The clamping force that the power of unclamping that patient's motion is produced and another bar are produced is offset by this way, so this set can improve the device whole reliability significantly.

Said device also has following technological merit according to the present invention:

The first, this device is a kind of fixture that is made of the rectangular configuration that two clamp-type contiguous blocks 1 that have a sliding

shoe

4,5 and two

bars

2,3 constitute, and the rectangular configuration of this device makes stability improve.In the device of prior art with bar, these two bars must be firmly fixed, so that place appropriate location (rectangular frameization) owing to structure of the present invention a cross-connecting apparatus, the rectangleization of device (frameworkization) can obtain automatically by a preceding fixed bar 3 is installed.

Have the intensity that can resist physiological load for a long time, can avoid a kind of incorporating period of undue length, make patient reactivate rapidly and need not the measure of external stability, and avoid the back near method insert that operation brings the required second time extra fixing.

Thereby provide a kind of probability (by relative compressing or dispersion) of carrying out three-dimensional correction restore intravertebral profile with apparatus to vertebra, correct the probability of deflection fully, and correct vertebra fully and reverse with hunchback so that the probability that spinal column restores balance again.

Little volume.This is not only for for being avoided contacting the consideration that large vein reduces thickness, also is for the consideration that reduces the amount of metal that uses.For example, this thickness second vertebra endosome in the back should not surpass 11 millimeters, in should be on the 3rd vertebral body above 9 millimeters.Can avoid interference like this to the bone graft consolidation.

Because the number of the parts of formation apparatus is few, make surgical installation simplify.Can reduce the number of required assistive device like this, and finally reduce the whole cost of apparatus.

The surgeon must be skilled and rapid when doing implant surgery, because foregoing reason, the surgeon must reduce nervous lesion as much as possible.

It is widely that the suitability of using makes this device not only use in the spinal column application, and if the different sizes and different shapes of its employing, also go for each position, the especially T of spinal column ₄To L ₅

Remove outside the above-mentioned characteristic, use this device to have significant safety and also be following such factor, Here it is each grappling hold-down screw 8 in case be inserted in its hole, is just stayed wherein, thereby thoroughly is enclosed in the inside.Really, when its corresponding sliding

shoe

5,4 after complete closure, and

columniform bar

2,3 is by sliding

shoe

5,4 are clamped in

screw

8,10 head, screw is pinned in the axial direction fully as a result, if a tool transverse breakage has appearred in its screw position, also not having though it can not be made a point for patient's influence, is very little really.

Be thorough closed sliding

shoe

4,5 the externally applied forces of wanting greatly to avoiding owing to each vertical flange (17 ... 20) and the action of its chamfered end 17a and to cause it to open unexpectedly just much of that, described chamfered end 17a allows to have precedence over along another direction (seeing Fig. 1 and Fig. 4) along inserting on the direction.Standard that Here it is on the surface of sliding

shoe

4,5 is with the reason of the direction of insertion of indicating each sliding shoe.But making this configuration must be by means of slidably and the slope of the vertical flange of clamping.

The upper surface of each piece 1 that is clamped and connected is very smooth, particularly it corresponding to the forward round lateral parts S that is placed on the vertebra ₁The surperficial S of the central part of the upper surface of same slick sliding shoe and contiguous block 1 and sidepiece ₁, S ₂Flush, which parts is the result do not have give prominence to, and this is a remarkable advantage of clamping shape contiguous block provided by the present invention.

The

screw

23,24 of

fastening sliding part

4,5 is by its tapering part 29 being fastened on the

flange

18 and 19 of sliding

shoe

4,5, for device provides more safety.This relates to about sliding

shoe

4,5 is fastened on bar C-D2, an additional security measure on 3, because under any circumstance, fastening effect is all by fastening be guaranteed of sliding shoe on bar.Therefore, screw 23,24 only plays an extra assosting effect.For fear of outstanding from the surface of contiguous block 1, on being fastened to contiguous block after, by means of the taper position 31 that can rupture, each

screw

23,24 is fractureed at an upper portion thereof.This fracture location occurs in the taper position 31 that can rupture and the junction between the fastening tapering part 29, that is the weakest position.Therefore in fact each

screw

23,24 is disappeared among contiguous block, because the plane of disruption is in surperficial about 2 to the 3 millimeters places apart from contiguous block 1.

To the second embodiment of the present invention shown in Figure 13, each contiguous block has a roughly shape of bending, is approximately L shaped cross section so that have one at Fig. 8.The two halves 41 and 42 of contiguous block 40 constitute its forward and backward part, the wherein thickness e of latter half 41 respectively ₁Thickness e greater than first half 42 ₂Be by a plane P between these two parts 41 and 42 in the bottom 44 of a groove 44 that is substantially perpendicular to latter half 41 ₁Total direction P central module 43 of go up stretching couple together.On the other hand, the plane P of a side of the bottom portion of groove of the direction P at central module 43 extension places and first half 42 ₂Between form one less than 90 ° angle B.As contiguous block 1, be provided with half-cylindrical groove 46,47 in the bottom of each groove 44,45 and on sliding shoe 4,5, be provided with complementary with it groove 46a, 47a, the diameter of the diameter of said groove and bar 2,3 is identical.The bottom of groove 46,47 has the hole 48,49 of admitting grappling hold-down screw 10 and 8 respectively.Attention is in Fig. 8 and Fig. 9, and groove 44 and 45 inlet chamfering 50,51 help the insertion of corresponding sliding shoe 4,5.In addition, the structure of contiguous block 40 and contiguous block 1 similar for the corresponding parts on both, will use identical reference number to represent.

After the various parts of this device had been assembled already (Figure 11 and Figure 12), anchor screws 8 and 10 passes latter half 41 respectively and first half 42 stretches out, and forms the angle about 35 ° to 40 ° between the two.Then, first half 42 be placed on one that make by the surgeon and open in this vertebra front portion (L for example ₃Or L ₁) the vertebra groove in (Figure 13).Therefore, the first half of clamp-type connector 40 is inserted into vertebral region.Angle between first half 42 and the latter half 41 is (corresponding to two plane P ₁And P ₂Between angle) again for paying close attention to pro-near providing more safety with the surgeon of trunk degree of closeness in the method operation.

First half S as previously described ₁ Edge 12 in the slight corners of its transverse direction, its radius of curvature is about 15 millimeters.It is corresponding that this specific shape and this connect the mean estimates of the concavity of vertebra in the vertebral region that

piece

1,40 will implant.Because the distribution of contacted several applied forces is improved, this structure obtains the needed stability of whole apparatus.

As previously described, sliding

part

4 and 5 direction of insertion are opposite, thereby after after a while, after patient recovered his activity again, sliding shoe can not become flexible.Really, trend towards making that bar 2(is used for derotation after the clamping) the loosening power of sliding shoe can be designed to make it opposite with the power that trends towards making the sliding shoe of the preceding bar 3 of clamping to unclamp or offset with it.Experience shows, it is desirable on the direction up slide block 4 is clamped on the bar 2 of back, on the direction down another bar 3 is clamped simultaneously.

Such setting has fabulous mechanical function.In the strength test of doing with static state or dynamic testing machine, use the general maximum, force that can produce of human body, still can not detect have in the connection loosening.

It must be understood that owing to there are many possible embodiments to be conceived to out, therefore can not think that the present invention only is confined to two embodiment that introduced.For than the longer vertebra joint of the represented vertebra joint that goes out of Figure 14, this apparatus also can have the contiguous block 1 of requirement, for example 3 or 4.

Similarly, opposite with the said embodiment of Figure 14, might two

bars

2 and 3 very different, for example back bar 2 length of extending surpasses preceding bar 3.In this case, two bars also can be fixed with foregoing mode, and that bar extends part can be fixed with at least one clamp-type contiguous block of the present invention, but only need have a

groove

6 or 7 on the contiguous block.Then, this contiguous block is fixed so that fix the extra length of this bar, be used to admit the groove of another bar then not need on the contiguous block.

The attachment device that is used for fastening sliding

shoe

4,5 that is made of two

screws

23,24 can be that each contiguous block 1 has only a screw, and this screw can be inserted in the medium pore of contiguous block.The diameter of this hole and screw must must be enough to guarantee adjacent two grooves of this hole by a lateral passage and sliding

shoe

4,5

side flanges

18,19 greatly, and (16a 16b) is connected.This screw has a tapering part 29, this tapering part location is made it to be meshed with said lateral access, and be pressed on the flange of sliding shoe, so that strengthen in their groove their fastening effect.

In addition, in this case, it may be favourable that hole 34 is dispensed, and can insert by the head with auxiliary device 36 in the centre bore of this screw and disperse-oppress operation.

Claims

1, preceding proximity spinal column osteosynthesis apparatus, said apparatus comprises: two rigid rods that are in the plane that parallels, at least two laterally connect said bar and to make it can endwisely slip and carry out contiguous block around the rotation of self therein, with the bar fastening mechanism that they can not rotate and move and osseous anchoring element that combines with said contiguous block of making in contiguous block.

2, according to the said apparatus of claim 1, wherein said two bars are parallel to each other.

3, according to the said apparatus of claim 1, wherein each contiguous block has a first half and a latter half, and on transverse direction from first half to latter half, have the be essentially arcual shape consistent with basivertebral front side anatomic construction, said contiguous block defines one and fits in vertebral body thereby be the outer surface of the inner surface of spill and a tool projection.

4, apparatus according to claim 3, the thickness of first half wherein be less than the thickness of latter half, and have a rounded edges.

5, apparatus according to claim 1, have two parallel grooves longitudinally on each contiguous block, each is used to admit a corresponding bar and a corresponding sliding shoe that is used for fastening said bar, each sliding shoe can be installed in the mode of longitudinal sliding motion in the corresponding longitudinal fluting, and is fastened on the corresponding bar at the terminal point that it moves.

6, device according to claim 5, each sliding shoe wherein all has an oblique side flange, be provided with complementary side channel in the corresponding grooves, said oblique side flange and said complementary side channel are complementary, be provided with oblique fastening slope in the said groove, said flange matches with said fastening slope, and said slope is 2 ° to 6 ° with the oblique angle that axis became of corresponding bar.

7, apparatus according to claim 6, wherein each flange of each sliding shoe has an end that at first enters corresponding recesses and chamfering, said corresponding grooves has an inlet that forms chamfering, so guide said sliding shoe to insert said groove.

8,, comprise the half-cylindrical groove at the admittance position of described bar set in the bottom of some grooves at said contiguous block and the described sliding shoe according to the said apparatus of claim 1.

9, according to the said apparatus of claim 1, comprise a hole of each bottom portion of groove that is positioned at each contiguous block and insert one of them bone anchor screws, form a suitable angle between the axis of said two holes and said anchor screws to obtain best grappling.

10, apparatus according to claim 9, said suitable angle is essentially 25 °.

11, apparatus according to claim 9, comprise that some formation are arranged in the half-cylindrical groove of receiving positions of the described bar of the bottom of described groove of described fixed block and described sliding shoe, open in the bottom of the corresponding half-cylindrical groove of accepting corresponding bar in each hole, makes each bone anchor screws be closed in its hole during clamped location by meshing fully with sliding shoe accordingly in corresponding grooves when corresponding bar.

12, apparatus according to claim 5, wherein each sliding shoe all have one with a mutually concordant surface of the convex surface of corresponding pair of nubs, thereby the surface of said convex surface and said each sliding shoe all is slick, has avoided occurring any projection.

13, apparatus according to claim 13, wherein each contiguous block has the complementary retention mechanism corresponding to corresponding sliding shoe.

14, apparatus according to claim 13, wherein for each sliding shoe, said complementary clevis is held mechanism and is comprised, screw in opening that can insert the corresponding fixing fast centre between described groove, said opening is connected with the adjacent slot of the side flange of described sliding shoe by a wing passage, have its position on the said screw and be defined in the tapering part that can be meshed with said side path, and can be pressed on the described flange of described sliding shoe, so that further it is fastened in the said groove.

15, apparatus according to claim 14, trip bolt wherein comprises to its other end from the one end: a threaded anchor, one be used for fastening described sliding shoe, towards the gradually thin tapering part of threaded rod direction, one towards said fastening tapering part direction gradually thin fracture tapering part and a head of screw.

16, apparatus according to claim 1, wherein said contiguous block has the curved shape that is essentially the S tee section, its half constituted first half, second half has constituted latter half, the thickness of said first half is less than said latter half, and can be inserted on the vertebral body to being inserted in the pit that is provided with.

17, apparatus according to claim 1, one of them bar are preceding bars, and another bar is the back bar, and the diameter of preceding bar is less than the back bar.

18, apparatus according to claim 6, wherein between two sliding shoes of each fixed block, the incline direction of the described side flange of described sliding shoe is opposite with the incline direction on relevant clamping slope.

19, apparatus according to claim 5 comprises a pit that is positioned on each groove walls, is used to support a card punch and gets out a prepared hole that is used for anchor screws is inserted the hole of vertebral body.

20, apparatus according to claim 1 comprises an opening on the first half that is positioned at each contiguous block, is used to admit a dispersion-compressing utensil.

21, apparatus according to claim 13, wherein said retention mechanism comprises a centre bore that is positioned on each contiguous block, the screw that can insert in the said centre bore, said hole and screw have enough big diameter, thereby said hole can be connected by the groove on the described side flange of side path and corresponding slide block, said screw has a tapering part, the position of this tapering part can be meshed it with said wing passage, and be pressed on the side flange of sliding shoe, further it is fastened among the pairing groove.

22, apparatus according to claim 6, wherein for the sliding shoe of same rod, the inclination of said slope and flange is to get mutually unidirectionally, and for the slope and the flange of the sliding shoe of another root bar, the inclination of slope and flange is towards rightabout.